Correlation of Clinical and Biochemical Findings with Diabetic Ketoacidosis-Related Cerebral Edema in Children Using Magnetic Resonance Diffusion-Weighted Imaging

Nicole Glaser, James P Marcin, Sandra L. Wootton-Gorges, Michael H. Buonocore, Arleta Rewers, John Strain, Joseph DiCarlo, E. Kirk Neely, Patrick Barnes, Nathan Kuppermann

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Abstract

Objective: To determine clinical and biochemical factors influencing cerebral edema formation during diabetic ketoacidosis (DKA) in children. Study design: We used magnetic resonance diffusion-weighted imaging to quantify edema formation. We measured the apparent diffusion coefficient (ADC) of brain water during and after DKA treatment in 26 children and correlated ADC changes with clinical and biochemical variables. Results: Mean ADC values were elevated during DKA treatment compared with baseline (8.13 ± 0.47 vs 7.74 ± 0.49 × 10-4 mm2/sec, difference in means 0.40, 95% CI: 0.25 to 0.55, P < .001). Children with altered mental status during DKA had greater elevation in ADC. ADC elevation during DKA was positively correlated with initial serum urea nitrogen concentration (correlation coefficient 0.41, P = .03) and initial respiratory rate (correlation coefficient 0.61, P < .001). ADC elevation was not significantly correlated with initial serum glucose, sodium or effective osmolality, nor with changes in glucose, sodium or osmolality during treatment. Multivariable analyses identified the initial urea nitrogen concentration and respiratory rate as independently associated with ADC elevation. Conclusions: The degree of edema formation during DKA in children is correlated with the degree of dehydration and hyperventilation at presentation, but not with factors related to initial osmolality or osmotic changes during treatment. These data support the hypothesis that CE is related to cerebral hypoperfusion during DKA, and that osmotic fluctuations during DKA treatment do not play a primary causal role.

Original languageEnglish (US)
JournalJournal of Pediatrics
Volume153
Issue number4
DOIs
StatePublished - Oct 2008

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Diabetic Ketoacidosis
Diffusion Magnetic Resonance Imaging
Brain Edema
Osmolar Concentration
Respiratory Rate
Urea
Edema
Nitrogen
Sodium
Therapeutics
Glucose
Hyperventilation
Serum
Dehydration
Water
Brain

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Correlation of Clinical and Biochemical Findings with Diabetic Ketoacidosis-Related Cerebral Edema in Children Using Magnetic Resonance Diffusion-Weighted Imaging. / Glaser, Nicole; Marcin, James P; Wootton-Gorges, Sandra L.; Buonocore, Michael H.; Rewers, Arleta; Strain, John; DiCarlo, Joseph; Neely, E. Kirk; Barnes, Patrick; Kuppermann, Nathan.

In: Journal of Pediatrics, Vol. 153, No. 4, 10.2008.

Research output: Contribution to journalArticle

Glaser, Nicole ; Marcin, James P ; Wootton-Gorges, Sandra L. ; Buonocore, Michael H. ; Rewers, Arleta ; Strain, John ; DiCarlo, Joseph ; Neely, E. Kirk ; Barnes, Patrick ; Kuppermann, Nathan. / Correlation of Clinical and Biochemical Findings with Diabetic Ketoacidosis-Related Cerebral Edema in Children Using Magnetic Resonance Diffusion-Weighted Imaging. In: Journal of Pediatrics. 2008 ; Vol. 153, No. 4.
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abstract = "Objective: To determine clinical and biochemical factors influencing cerebral edema formation during diabetic ketoacidosis (DKA) in children. Study design: We used magnetic resonance diffusion-weighted imaging to quantify edema formation. We measured the apparent diffusion coefficient (ADC) of brain water during and after DKA treatment in 26 children and correlated ADC changes with clinical and biochemical variables. Results: Mean ADC values were elevated during DKA treatment compared with baseline (8.13 ± 0.47 vs 7.74 ± 0.49 × 10-4 mm2/sec, difference in means 0.40, 95{\%} CI: 0.25 to 0.55, P < .001). Children with altered mental status during DKA had greater elevation in ADC. ADC elevation during DKA was positively correlated with initial serum urea nitrogen concentration (correlation coefficient 0.41, P = .03) and initial respiratory rate (correlation coefficient 0.61, P < .001). ADC elevation was not significantly correlated with initial serum glucose, sodium or effective osmolality, nor with changes in glucose, sodium or osmolality during treatment. Multivariable analyses identified the initial urea nitrogen concentration and respiratory rate as independently associated with ADC elevation. Conclusions: The degree of edema formation during DKA in children is correlated with the degree of dehydration and hyperventilation at presentation, but not with factors related to initial osmolality or osmotic changes during treatment. These data support the hypothesis that CE is related to cerebral hypoperfusion during DKA, and that osmotic fluctuations during DKA treatment do not play a primary causal role.",
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AU - Buonocore, Michael H.

AU - Rewers, Arleta

AU - Strain, John

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